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Sinusitis is an inflammatory process of an infectious nature that affects the mucous membrane of the paranasal sinuses. Sinusitis can be caused by viruses, bacteria, mycotic organisms, and allergens.
This disease is quite common and is diagnosed in 0,02% of adults. In 0,5% of cases, sinusitis is a complication of SARS in childhood. Otolaryngologists refer to sinusitis such diseases as:
Sphenoiditis (inflammation of the sphenoid sinus);
Frontitis (inflammation of the frontal sinuses);
Sinusitis (inflammation of the maxillary sinuses);
Etmoiditis (inflammation of the ethmoid bone of the labyrinth).
Sinusitis can be acute or chronic. If there is no treatment, it is possible to develop serious complications that threaten not only the health, but also the life of the patient.
Causes of sinusitis
The causes of sinusitis are almost always inextricably linked with the stagnation of the secret in the paranasal sinuses, the violation of their aeration and subsequent infection. In total, there are 8 sinuses. The nasal cavity communicates with each of them due to the presence of narrow passages. If this regular drainage is disturbed, favorable conditions are created for the development of sinusitis.
The worsening of sinus clearance can occur for the following reasons:
Violation of intranasal structures as a result of their deformation. Often this is due to hypertrophic rhinitis, which is a chronic sinus disease associated with the growth of bone tissue and mucous membranes. Also, the curvature of the nasal septum, which occurs as a result of mechanical damage to the plate dividing the nasal cavity into two parts, can disrupt normal drainage. The third reason for the deformation of the intranasal structures is congenital anomalies in the structure of the turbinates and the ethmoid labyrinth.
The penetration of a viral infection into the body often causes the development of sinusitis. The mucous membrane lining the nasal sinuses reacts to the introduction of a pathogenic agent with inflammation and swelling. The glands located in the nasal mucosa begin to work in an enhanced mode and secrete an increased amount of secretion. As a result, the passages between the sinuses and the nasal cavity are narrowed even more, clogged with thick contents. The ventilation of the sinuses is completely disrupted, resulting in the development of sinusitis.
The bacterial flora can also cause the development of inflammation of the paranasal sinuses. Most often, bacterial infection occurs against the background of a viral infection. Stagnation of mucus, lack of oxygen, lack of adequate ventilation – all this leads to the creation of favorable conditions for the reproduction of bacteria. The more often a person uses antibacterial drugs to treat viral rhinitis, the higher the risk that the bacterial flora will become resistant to them. This, in turn, will complicate the treatment process, make it long and laborious.
The fungal nature of sinusitis has been observed more and more often in recent years. This is also explained by the irrational use of antibiotics. They adversely affect the state of human immune defense, disrupt the natural microflora of the nasal sinuses, create favorable conditions for the reproduction of mycotic microorganisms in them.
Sinusitis does not always have a microbial etiology. It is also possible to develop inflammation due to exposure to cold, for example, when inhaling cold air.
Exposure to the mucous membrane of chemicals becomes a predisposing factor for the development of sinusitis in the future.
Vasomotor rhinitis, which is provoked by allergic reactions of the body, causes sinusitis in 80% of cases. Therefore, allergies are the most common cause of inflammation of the paranasal sinuses. The mechanism of the development of the disease is explained by the constant, multiple edema of the mucous membrane of the respiratory tract, which leads to chronicization of the process.
Another reason that can provoke the development of sinusitis is the pathology of the roots of the teeth (oroantral fistula, chronic periodontitis). After tooth extraction, or due to infection of the maxillary sinus, sinusitis may develop. The filling of the dental canal can also lead to the development of sinusitis, especially often this happens when the filling material enters the maxillary sinus. In this case, predominantly mycotic sinusitis develops.
Perhaps the development of sinusitis against the background of immunodeficiency.
Violation of the microflora of the sinuses
American scientists note that one of the reasons why sinusitis develops is a violation of the normal microflora in the sinuses. The number of those bacteria that inhibit the growth of opportunistic flora begins to fall, resulting in inflammation.
According to various sources, about 15% of the world’s population suffers from sinusitis. The main cause of the development of bacterial inflammation are staphylococci and streptococci. However, it is known that these microorganisms can be present in the human nasopharynx, but not provoke the development of the disease in him. Therefore, only the fact of their presence in the nasal cavity does not mean the development of sinusitis.
Scientists at the University of California at San Francisco conducted a laboratory study of the microflora of the nasal sinuses in people with chronic sinusitis and in healthy people. The results of the study are such that in patients with sinusitis, the nasal mucosa is dominated by Corynebacterium, which is found in the nome on the skin, in the respiratory tract, and in the gastrointestinal tract. In healthy people, the microflora of the mucous membrane of the nasal sinuses is represented mainly by Lactobacilli.
As for Corynebacterium tuberculostearicum, it is not absolutely pathogenic for the human body, however, in large quantities it can lead to the development of inflammatory processes. So, when these bacteria were injected into the nasal sinuses of mice, the animals developed sinusitis. When the sinuses were colonized with Lactobacilli, inflammation did not occur, just as with the simultaneous administration of Lactobacilli with Corynebacteria.
The scientists who conducted the experiment came to the conclusion that Lactobacilli are able to control the growth of other, opportunistic microorganisms. However, experts are not yet able to explain the mechanisms of this process. However, it is possible that in the near future, to rid a person of sinusitis, it will be possible to inject into the nose not an antibiotic, but beneficial bacteria.
The balance of bacterial microflora is important for the nose, mouth, intestines, and vagina. If it is disturbed, a disease develops. Although the studies are not yet completed, the results obtained are very encouraging. There is speculation that many bacterial infections will soon be able to be treated without the use of antibiotics.
The symptom is sinusitis
Depending on which sinus has been inflamed, the symptoms of sinusitis will vary:
Symptoms of sinusitis:
Acute onset with an increase in body temperature up to 38 ° C and above.
Symptoms of intoxication of the body.
Chills.
Pain in the region of the maxillary sinus, in the frontal zone, near the root of the nose and along the zygomatic bone.
Increased pain on pressure, radiating to the temples.
Headaches of varying severity.
Deterioration of nasal breathing on the side that was involved in the pathological process. Breathing is done through the mouth.
There may be lacrimation.
Discharge from the nasal passages is at first serous and liquid, and as the disease progresses, it becomes green and cloudy.
If the disease acquires a chronic course, then during the period of remission it reminds of itself with rare headaches, which are expressed in a feeling of pressure behind the eyes. Accession of cough at night, conjunctivitis, keratitis is possible. Discharge from the nose is insignificant, their volume increases during an exacerbation of the disease.
Symptoms of ethmoiditis:
A person experiences pain in the region of the bridge of the nose and the root of the nose.
In childhood, reddening of the conjunctiva, swelling of the upper and lower eyelids is possible.
Headaches and pains of a neurological nature are not excluded.
Body temperature increases.
The olfactory function is disturbed, nasal breathing is difficult.
If ethmoiditis is acute, it is possible to involve the eyeball in the pathological process with its protrusion, as well as severe swelling of the eyelids.
With sinusitis of the frontal sections of the ethmoidal labyrinth, the parallel development of sinusitis and frontal sinusitis is likely. With inflammation of the posterior ethmoidal labyrinth, sphenoiditis may develop.
Frontal symptoms:
Nasal breathing is extremely difficult.
Body temperature increased to high levels.
From the side of the inflamed nasal sinus, serous contents are separated.
The pains are very intense, the place of their localization is the forehead. Pain worsens in the morning.
Perhaps the development of photophobia with pain in the orbits.
After the inflamed sinus is empty, the intensity of pain decreases.
If frontitis develops against the background of influenza, then the patient may have a change in the skin of the forehead with swelling of the areas above the eyebrows and swelling of the upper eyelid.
Frontal sinusitis is more difficult for patients to tolerate than other sinusitis. With chronicization of the process, the growth of polyps in the nasal cavity, necrosis of bone tissue, and the formation of fistulas are possible.
Symptoms of sphenoiditis:
Pain is localized in the region of the orbit, in the parietal zone and in the occipital part.
The patient may complain of pain in the depths of the head.
The chronic course of the disease can provoke visual impairment, since the optic nerves are involved in the pathological process.
Often the symptoms of sphenoiditis are blurred and the disease is hidden.
The ethmoid sinus is often involved in the inflammatory process, so isolated sphenoiditis is rarely diagnosed.
There are three forms of sinusitis, which differ depending on the nature of the discharge from the nose:
Edematous-catarrhal form – serous, transparent discharge.
Purulent form – discharge is purulent, yellow or green, with an unpleasant odor.
Mixed form – serous discharge with impurities of pus.
Diagnosis of sinusitis
Sinusitis is usually not difficult to diagnose. A specialist is able to suspect inflammation of the sinuses only on the basis of the clinical picture of the disease, after examining the patient.
To confirm sinusitis, additional tests will be required, including:
X-ray examination of the paranasal sinuses, the picture must be taken in two projections (the disadvantage of this research method is that the level of fluid in the sinuses cannot be visualized, as well as assessing the condition of the ethmoid sinuses);
ultrasound, used as a screening test;
CT of the paranasal sinuses is the most informative study.
Depending on the indications, the appointment of CT and MRI of the brain is possible.
Complications of sinusitis
Complications of sinusitis can pose a serious threat to a person’s health.
Among the negative consequences that the disease can cause:
The spread of the pathological process deep into the tissues with damage to the bones and the formation of osteomyelitis.
Orbital complications, accompanied by pain in the orbit, impaired eye mobility, development of exophthalmos, loss of vision. Treatment is carried out with the obligatory participation of an ophthalmologist.
Perhaps the development of otitis media.
Meningitis, arachnoiditis. This complication occurs mainly with damage to the ethmoid bone and sphenoid sinus.
Frontitis is dangerous epidural or subdural abscess of the brain.
In the most severe cases, in the absence of adequate assistance, a fatal outcome is possible, since any intracranial complications have a poor prognosis.
Treatment of complications of sinusitis should be carried out strictly in a hospital setting. Assistance to the patient is reduced to mandatory surgical intervention with drainage of the focus of infection after it has been opened. However, even against the background of powerful antibiotic therapy, the prognosis of intracranial complications is unfavorable.
Answers to popular questions
Is it possible to warm the nose with sinusitis? With sinusitis, you should not warm your nose. This is a direct contraindication in the acute stage of the inflammatory process. Warming up is not only able to save a person from the disease, but can also lead to a deterioration in the patient’s condition, with the spread of infection into the deep structures of the skull.
Is it possible to do inhalation with sinusitis? Inhalations for sinusitis can be done if this method of treatment was recommended by an otolaryngologist after examining the patient.
Is it possible to go to the bath with sinusitis? Going to the bath is contraindicated in acute sinusitis, as there is a threat of a breakthrough of the contents of the nasal sinus into the bloodstream. In addition, the bath is prohibited against the background of high body temperature, which almost always accompanies the development of sinusitis.
How to treat sinusitis?
You should not make a decision on how to treat sinusitis on your own. Therapy of this disease is within the competence of an otolaryngologist. The sooner inflammation is diagnosed, the more effective treatment will be.
Taking antibacterial drugs. Current recommendations for the treatment of bacterial sinusitis suggest antibiotics.
The use of drops to facilitate nasal breathing and to relieve swelling. Symptomatic treatment is shown, aimed at stopping the pain syndrome, at restoring normal drainage of the sinuses.
Antipyretics for sinusitis. When the body temperature exceeds 38,5 ° C (for adults), it is necessary to knock it down by taking antipyretics.
Antiallergic therapy. Antihistamines are used if sinusitis is allergic in nature. With viral sinusitis, experts do not recommend the use of antihistamines. A drying effect can be obtained, but there is a risk of worsening the outflow of mucus from the paranasal sinuses.
The use of antiseptics. Antiseptics are used to treat viral sinusitis. They allow you to improve the outflow from the paranasal sinuses and sanitize the nasal cavity. The selection of an antiseptic should be carried out by a doctor, since each drug has certain contraindications and can cause side effects.
Rinsing the nose. For uncomplicated sinusitis, a procedure such as washing the nose is possible. To do this, you can use both special ready-made pharmacy solutions and regular saline.
Treatment of sinusitis of fungal etiology. If the cause of sinusitis is a fungal infection, it is necessary to use antimycotics. The drug and dosage is determined by the attending physician.
Surgery. Surgical treatment of sinusitis is necessary in the case when conservative treatment has not given a positive result, if the inflammation develops against the background of abnormalities in the development of the sinuses, and also in the case when there is a threat to the patient’s health.
Operations can be both endonasal with access through the nose, and exonasal with extranasal access to the sinuses.
Endonasal surgery is performed using endoscopic equipment. This allows you to access even the most inaccessible places, remove existing polyps, overgrown bone tissue, etc. during the operation. At the same time, the integrity of the nasal septum is maximally preserved, and the recovery period passes in a short time.
It is also possible surgical intervention according to the method of Ogston-Luc, Caldueffl-Luc. However, minimally invasive surgery using endoscopic equipment is a priority in modern otolaryngological surgery.
A minimally invasive surgical intervention includes a puncture of the nasal sinuses. This method allows you to remove purulent contents from them and inject an antibacterial agent directly to the site of inflammation.
The prognosis for sinusitis is usually favorable if therapy is started in a timely manner.